Vidal Liat, Shpilberg Ofer, Gurion Ronit, Monsef Ina, Raanani Pia, Ram Ron, Gafter-Gvili Anat
a Institute of Hematology, Beilinson Hospital, Rabin Medical Center , Petah Tikva , Israel.
b Tel Aviv University, Sackler Faculty of Medicine , Israel.
Acta Oncol. 2016;55(1):77-84. doi: 10.3109/0284186X.2015.1043025. Epub 2015 May 21.
R-CHOP-21 has remained the standard chemotherapy for aggressive non-Hodgkin's lymphoma. It was suggested that decreasing the treatment interval from three weeks (CHOP-21) to two weeks (CHOP-14) may improve survival and disease control of patients with aggressive lymphoma.
To evaluate the effect of CHOP-like-14 (with or without rituximab) compared to standard CHOP-like -21 on overall survival (OS), disease control and toxicity of patients with aggressive non-Hodgkin lymphoma.
Systematic review and meta-analysis of RCTs. In October 2014 we searched The Cochrane Library, MEDLINE, LILACS, conference proceedings, and databases of ongoing trials. Authors were contacted for complementary data. The primary outcome was OS.
We identified seven trials (4073 patients), conducted between the years 1999 and 2008. Trials were at low or unclear risk for selection bias, and at low or unclear risk of attrition bias. CHOP-like-14 improved OS of patients with aggressive lymphoma compared to the same regimen given every 21 days (all trials): HR of death 0.86, 95% confidence interval (CI) 0.77-0.97. There was no OS difference between rituximab-CHOP-like 14 to rituximab-CHOP-like-21 (3 trials): HR 0.93 95% CI 0.78-1.10. The rates of progression or death, complete response, treatment-related mortality, grade 3-4 infection, and discontinuation were similar between groups.
R-CHOP-21 remains the standard of care for patient with aggressive B-cell lymphoma. CHOP-14 can be considered as in case rituximab is omitted.
R-CHOP-21一直是侵袭性非霍奇金淋巴瘤的标准化疗方案。有人提出将治疗间隔从三周（CHOP-21）缩短至两周（CHOP-14）可能会提高侵袭性淋巴瘤患者的生存率和疾病控制率。
评估与标准CHOP-21方案相比，CHOP-14方案（联合或不联合利妥昔单抗）对侵袭性非霍奇金淋巴瘤患者总生存期（OS）、疾病控制和毒性的影响。
对随机对照试验进行系统评价和荟萃分析。2014年10月，我们检索了考克兰图书馆、MEDLINE、LILACS、会议论文集以及正在进行的试验数据库。与作者联系以获取补充数据。主要结局指标为总生存期。
我们纳入了1999年至2008年间开展的7项试验（4073例患者）。试验存在低或不明确的选择偏倚风险，以及低或不明确的失访偏倚风险。与每21天给予相同方案相比，CHOP-14方案改善了侵袭性淋巴瘤患者的总生存期（所有试验）：死亡风险比为0.86，95%置信区间（CI）为0.77-0.97。利妥昔单抗-CHOP-14方案与利妥昔单抗-CHOP-21方案之间的总生存期无差异（3项试验）：风险比为0.93，95%CI为0.78-1.10。两组之间的疾病进展或死亡率、完全缓解率、治疗相关死亡率、3-4级感染率和停药率相似。
R-CHOP-21仍然是侵袭性B细胞淋巴瘤患者的标准治疗方案。如果省略利妥昔单抗，CHOP-14方案可作为备选方案。
